22 September, 2005

The dead, one gets used to seeing. Viewing a recently deceased person, touching a rapidly cooling body through gloved hands, even sometimes hearing the last inhaled air exit the body as I turned a decedent over to examine them took awhile longer to grow accustomed to. The recency of the departed life can often have a strong impact on even the strangers who are present.

Actually watching someone die is a different experience entirely. I never did acquire any level of comfort with this. I’ve lost a number of loved ones, but with none of them was I present for their actual death. I know plenty of people who have experienced this and found it somewhat peaceful - while still deeply sad - to be with a person drawing his or her last breath. Watching someone die violently is vastly different, of course. I have not witnessed a violent death in person – only on videotape. That is more than enough for me.

One videotape was from scene I personally worked. I was called out around 4:30 AM to a convenience store where the clerk had been found dead with no apparent injuries. The scene appeared non-violent and unremarkable with two exceptions: the emergency phone was off the hook, and a partially eaten English muffin breakfast sandwich was sitting next to the microwave behind the counter.
No signs of violence at the scene. No external injuries to the decedent. He was a moderately obese middle-aged man – potential candidate for natural disease such as myocardial infarction (heart attack), cerebral vascular accident (stroke), and the like. He was warm to touch, no rigor mortis, very early blanching livor mortis (blood settling to the dependent portions of the body). He had several missing teeth.

No resuscitation attempts as reported by medics. The consensus being tossed around by police was “heart attack.”

Not so fast, guys. He had been eating - a more important clue than one might think. Eating, missing teeth, phone off the hook; I was concerned about this.

A store manager arrived and pulled the surveillance tape. The tape revealed that the man had indeed been alone, heated up his sandwich, took a bite or two, then appeared to be choking. After what seemed like an endless amount of time (probably to him as well), during which he picked up the emergency phone and attempted to force the food bolus from his trachea by slamming himself into the countertop, he collapsed. What a horrible way to die.

To further add to this tragedy, it was later discovered that his missing teeth were the result of a recent pistol-whipping that occurred while he was working at another convenience store. As a result, he was moved to different branch in a safer area.
Cause of death: a) Asphyxiation b) Choking
Manner of death: Accident

The two people I watched die in person both died in a hospital, and both were transplant cases. I’m a huge believer in organ, bone, and tissue donation, and even worked as a tissue recovery specialist in Kansas City for awhile. It’s important to share this as my intention is not to scare anyone away from the idea of donation or the process itself. It can be fairly brutal to watch due to the time-sensitivity issue of certain living organs.

The first case of this nature I had was a college student who, at the persuasion of her boyfriend, tried heroin for the first time with him. The result was a coma from which she never awakened. After she was declared brain dead (over a period of days, possibly even weeks), the family signed the organ donation papers. In our office, it was standard practice that, if at all possible, an investigator be present during the organ recovery to document postmortem alterations to the body (like incisions, etc.). I had scrubbed in and assisted with a liver recovery once before, and this was a finely-tuned surgical procedure quite unlike autopsies. This organ recovery was nothing like either.

First of all, the transplant procurement specialists are required to leave the OR before the life support machines are turned off and remain outside the OR for a set period of time (I think it was 10 minutes) after the patient is pronounced dead. So the machines were shut off, one by one, while every action was documented. I stood behind her head, and I remember watching the monitors and thinking “Come on – breathe on your own” – as though I could help will her heart to keep up the life-sustaining rate. It did not, and after a few minutes, she was pronounced dead.

When the transplant team came in, it was clock-watching time. It seemed, from my point of view, that they ripped into her chest wall. I know that from a technical perspective, it was much more precise than this, but watching them wield scalpels faster than I ever knew was possible while packing ice into the chest cavity was unlike anything I had yet seen.

I take comfort, as I hope her family and friends did, knowing that her donation saved and/or improved the lives of others.

The second was very much like the first, and the circumstances were also heartbreaking. I will relay the story of a multiple shooting in another chapter. See the upcoming “contagious waste disposal” for full description.